On September 6, 2013, a group of key opinion leaders met with a team from Johnson & Johnson at its annual National Advisory Panel and agreed upon the following consensus statement on plaque control for 2014: “Fundamental to an individual’s oral health is a high standard of plaque control.
This is most effectively achieved and maintained by twice daily mechanical cleaning with a fluoride toothpaste, interdental cleaning as advised by a dental healthcare professional, and the use of a clinically proven mouthwash most appropriate to the needs of the individual. This is part of the overall
package of oral care recommended by the dental healthcare professional team.” Here, Johnson & Johnson considers some of the evidence supporting that statement.
Plaque control
Figures suggest that two-thirds of UK dentate adults have visible plaque on at least one tooth. The Adult Dental Health Survey states: “Bacterial plaque is associated with both dental decay and periodontal disease and its removal is a key preventive behaviour for both diseases. Likewise, the presence of calculus, a form of hardened plaque, while not in itself an indicator of periodontal disease, is regarded as an important risk factor since it can impair effective cleaning and plaque removal.”
Writing about Loë and colleagues’ “now-classic study”, Barnett stated: “This study clearly demonstrated the temporal relationship between the accumulation of plaque and the development of gingivitis, thereby emphasizing the importance of plaque control in a preventive regimen for
periodontal diseases as well as for dental caries.”
Oral care at home
The Adult Dental Health Survey states: “Good oral hygiene helps prevent dental problems such as the accumulation of plaque and calculus, which contribute to the development of gum disease and tooth decay. Daily preventive care including brushing is nowadays seen as essential to maintain
good oral health and will help stop dental problems before they develop.
Evidence based guidance from the Department of Health recommends
that people brush their teeth twice a day with a fluoride toothpaste.
Supported by more than half a century of research, the benefits of fluoride
toothpaste are firmly established and systematic reviews have concluded that there is clear evidence that fluoride toothpastes are effective in preventing caries. Fluoride is known to strengthen tooth enamel, making it more resistant to tooth decay, and reduce the amount of acid produced by bacterial plaque on teeth.”
Sharma and colleagues wrote: “Mechanical methods of dental plaque removal have existed for centuries. Nearly a century ago, the ADA recommended the mechanical oral care regimen of twice daily toothbrushing and daily interdental cleaning (for example, flossing). To this day, this regimen is regarded widely as being a highly effective means of helping control dental caries and periodontal disease, both of which are plaque-mediated conditions and rank among the most common diseases in humans.”
Brushing and flossing/interdental cleaning are pivotal to oral hygiene. They displace plaque and dislodge bacteria that can cause gingivitis and periodontal disease from the tooth surface. But while mechanical cleaning is critical for good oral hygiene, the bacteria displaced and dislodged by these processes can quickly recolonise on teeth.
It is also recognised that the effectiveness of a patient’s mechanical cleaning technique is important if fluoridated toothpaste is to achieve its greatest value in preventing caries. On this issue, Albertsson et al (2010) wrote: “In
several individuals, the level of oral hygiene is still insufficient at many sites in order to provide a good plaque control consistent with oral health. During the last years, there has been a reemerged interest in the use of mouthrinses for chemical plaque control as [an] adjunct to daily mechanical plaque control.”
Indeed, mouthwashes offer the benefit of making contact with areas that are difficult to reach, helping patients to improve their home oral care. The hydrodynamic ability of a fluoridated mouthwash allows it to reach all five exposed tooth surfaces, so, given the scientific evidence supporting its efficacy, for most patients it is a logical adjunct to a daily prevention regime that offers protection for dental hard tissue.
In 2006, Gunsolley published a meta-analysis of six-month studies of anti-plaque and anti-gingivitis agents. He wrote: ‘‘This systematic review provides strong evidence that anti-plaque (...) agents are efficacious. Coupled with reports showing that the relative efficacy of these agents is similar to that of
flossing, these results suggest that to help achieve optimum [oral] health,
adults should add an anti-plaque (...) agent to their oral hygiene regimen.”
The overall package
So wrote van der Weijden and Slot (2013): “Plaque control is the cornerstone for the prevention and control of periodontal disease and caries. However, although salivary flow has some limited potential in cleaning debris from interproximal spaces and occlusal pits, it is less effective in removing and⁄or washing out plaque, and natural cleaning of the dentition by physiological forces – ie, movement of the tongue and cheeks – is virtually non-existent. Therefore, to be controlled, plaque must be removed frequently by active methods, and evidence from large cohort studies has demonstrated that high standards of oral hygiene will ensure effective plaque removal. There is substantial evidence showing that toothbrushing can control plaque, provided that cleaning is sufficiently thorough and performed at appropriate intervals.”
The evidence supporting the consensus statement issued by the National Advisory Panel suggests that it is important patients embrace a home care regimen – comprising brushing with a fluoride toothpaste, interdental cleaning and using a clinically-proven mouthwash – as part of an overall package of oral care in order to control plaque between appointments.
References available on request.
The key opinion leaders at the National Advisory Panel meeting were:
? Professor Iain Chapple, head of periodontology within the School of Dentistry, College of Medical and Dental Sciences, University of Birmingham;
? Professor Philip Marsh, professor of oral microbiology, School of Dentistry,
University of Leeds;
? Professor Nigel Pitts, director of the Dental Innovation and Translation Centre at King’s College London Dental Institute;
? Susie Sanderson, who practised for many years within the NHS framework in the South Yorkshire region;
? Sally Simpson, a dental therapist and an active member of the British Society of Dental Hygiene & Therapy;
? Professor Jimmy Steele, head of school and professor of oral health services research at Newcastle University’s School of Dental Sciences;
? Professor Nairn Wilson, chair of the national advisory panel and honorary
professor of dentistry at King’s College London; and
? David Winkler, a practising dentist based in Windsor and international
lecturer.